Common injuries at RODEOHOUSTON

Rodeo has returned to Houston! Last week, we shared what a typical day was like for the RodeoHouston® sports medicine team. To recap, Houston Methodist serves as the official health care provider for RodeoHouston. The sports medicine team consists of medical volunteers from across the city, who take care of the rodeo athletes and their families before, during and after the competitions.

Just like any other elite athlete, @rodeohouston competitors deal with injuries. Click To Tweet

Just like any other elite athlete, rodeo competitors deal with injuries. But did you know the types of injuries vary by competition? I talked to Dr. Timothy Sitter, the lead orthopedic surgeon on the RodeoHouston sports medicine team, about the rodeo injuries he’s seen in his nearly 20 years working with RodeoHouston.

Tie-Down Roping and Steer Wrestling: The most common injuries in these rodeo athletes occur in the knee. “If you’ve ever wondered why the dirt on the stadium or arena floor is being tilled up between events, it’s to keep it soft for events like tie-down roping and steer wrestling,” Dr. Sitter said. “These cowboys are coming down off their horses fast, so they keep the dirt around one foot-thick and soft because hitting a hard surface, like packed dirt, can cause a lot of damage to the knee.”


Team Roping: As part of this event, the cowboy or cowgirl must wrap the rope around their saddle horn a few times after they’ve roped the steer. Because the steer will pull on and tighten the rope, the competitor’s must wrap the rope around the saddle horn quickly and be sure to get their hands out of the way. Many riders have gotten their fingers caught in the rope while wrapping it around the saddle horn causing damage to or even losing a finger.


Bareback and Saddle Bronc Riding: “Elbow and shoulder injuries are common in this event,” Dr. Sitter said. “The cowboys are holding on to the rope to stay on the horse, so their shoulder and elbow are under a lot of stress. These athletes deal with a lot of sprains, strains and ligament tears.” Dr. Sitter added that most of these cowboys also wear neck collars to help prevent whiplash.

Barrel Racing: The key to barrel racing is to make tight turns around the barrels. Dr. Sitter said many of the cowgirls will hit their knees on the barrels, which can cause ligament tears and even fractures.


Bull Riding: One might think that the most common injury in bull riders is caused by whiplash or getting their hand caught in the rope, but the most common injury in these athletes is to the groin and hip. “The cowboys are holding on to the bull with their knees,” Dr. Sitter said. “The groin and hip muscles are straining because the knees are clinching on to the bull. Many bull riders work on increasing the flexibility in their hips to help prevent groin and hip muscle strains.”

No matter the event or injuries, the cowboys and cowgirls at RodeoHouston have a multi-disciplinary team at the ready to take care of them and get them back in the saddle.

Behind the scenes at RODEOHOUSTON

f you live in or near Houston, March is the month you pull out your western gear and become a cowboy or cowgirl to celebrate the return of the Houston Livestock Show and Rodeo™. RodeoHouston® has it all – a BBQ cook-off, mutton bustin’ for the kiddos, bull riders, barrel racers and hit music stars.

While Houstonians enjoy the festivities for the entire month of March, the rodeo contestants come to town to compete for three days before moving on to the next rodeo. Sprains, strains, fractures, concussions – these are just a few of the injuries contestants risk when they enter the competition. To continue their sport, contestants need a team of health care professionals to back them up. That’s why Houston Methodist is proud to serve as the official health care provider for RodeoHouston.

In a typical night, the @RodeoHouston sports medicine team averages 60-70 treatments for the contestants. Click To Tweet

Houston Methodist coordinates the RodeoHouston sports medicine team with medical volunteers from across the city to ensure a multi-disciplinary team is available to care for contestants and their families. For the sports medicine team, the show starts long before you find your seat in NRG Stadium. A typical day in the RodeoHouston training room looks like this:

  • 9 a.m. – 12 p.m. – A physical therapist treats athletes and Rodeo staff (think Rodeo clowns and other support staff) for injuries sustained the night before or pre-existing injuries
  • 12:00 – 1:00 p.m. – Lunch break (eat while you can!)
  • 1:00 – 2:00 p.m. – Restock supplies (we go through a lot of tape and ice)
  • 2:00 – 4:00 p.m. – Prepare for the pre-event madness
  • 4:00 – 6:00 p.m. – The competitions usually start around 6 p.m., so between 4 and 6 p.m. is the madness.

In a typical night, we’ll average 60 to 70 treatments for the rodeo contestants. The cowboys and cowgirls come in to ice sore muscles, get therapy for aches and pains, tape their ankles, ask the primary care physician about a lingering health issue like a cold or get the surgeon’s opinion on a recurring shoulder problem. Our team also performs and reads x-rays on-site. 

At the same time, we’re treating the rodeo athletes’ family members. Many contestants travel with their spouses and children, so they need medical care while on the road, too. It may be the husband of a barrel racer with back pain or the son of a bull rider with an ear infection – the team can take care of them all. 

When the competition starts, the contestants know the same team of medical experts taking care of them in the training room will be standing by in case a ride doesn’t go their way. In the arena, two athletic trainers, two emergency medicine/trauma physicians, a team of paramedics and an orthopedic surgeon are ready to provide care if a rider is injured. In case of a concussion, we have neuropsychologist on call to provide an evaluation and treatment recommendations.

When the rodeo is over and the fans are waiting for the concert to begin, the training room is once again packed with athletes coming in to see the medical staff. While not all injuries that occur on the arena floor are serious, they can cause problems if left untreated before the next rodeo in the next town. 

The next day, the cycle repeats. Although the medical staff may change from day to day, we all have the same mission and provide the same level of care for each of the athletes and their family members.

After three days, the contestants move on to the next rodeo, and at the end of March, the medical staff will go back to their normal practices. So, if you’re heading to the rodeo, keep an eye out for the guys and gals in red vests. We’ll be there all night, every night, keeping the contestants at their best. Yeehaw!

BYOL: Bring your own ligaments

t’s funny how things change as you age. For instance, we all reach a point where we don’t have to have the newest or best of everything – we just need something that works. You might feel that way about your car or your phone, but what about your ACL and PCL?

A new total knee replacement features a shape that protects that island of bone & saves the ligaments Click To Tweet

The ACL, or anterior cruciate ligament, and PCL, or posterior cruciate ligament, are located in your knee and are essential to natural knee movement and function. That’s why you hear about so many athletes getting a torn ACL repaired – you need those ligaments to function properly.

“These ligaments provide stability for the joint and increase the patient’s ability to perform complex movements, such as dancing, gardening or golfing,” explained Dr. Bill Bryan, a Houston Methodist orthopedic surgeon.

When you are old enough for a knee replacement, your ACL and PCL are certainly a bit worn out, but they still work, which is good enough for you. So why do surgeons remove the ACL and PCL when you have a knee replacement? Until now, they’ve not had an option.

A traditional total knee replacement requires removing the “island” of bone to which the ACL and PCL are attached. A new total knee replacement implant features a shape that protects that island of bone and saves the ligaments.

Dr. Bryan was one of 10 surgeons from across the country and the only surgeon in Houston to be selected as an early evaluator of the XP knee, made by Biomet, which features the new ligament-saving design.

“Most of my knee replacements patients are completely happy with their new knee, but some complain that they are not able to physically do everything they previously could,” Dr. Bryan said. “By saving the ligaments, this knee implant provides an improved range of motion and increases joint stability and natural movement for knee replacement patients,” Dr. Bryan said.

Dr. Bryan believes that another benefit of saving the ACL and PCL for knee replacement patients is that the ligaments will take some of the strain off the metal and plastic components of the knee replacement and help it to last longer. Most artificial knees last approximately 10 years before needing to be replaced.

“For many years, orthopedic surgeons have recognized the need for total knee replacements that save the ligaments,” Dr. Bryan said. “Now that technology and design have caught up with us, patients can now get a total knee replacement that works and feels a lot like a normal knee.”

How often do ACL tears happen to athletes?

How’s your fantasy football team doing? Lost any star players to an anterior cruciate ligament or ACL tear? St. Louis Rams quarterback Sam Bradford is out for a tear in his left knee for the second season in a row. Stephen Tulloch, a linebacker for the Detroit Lions, went down in week three with an ACL tear in his left knee.

ACL tears are common in football players and in professional, amateur and youth athletes in other contact sports with more than 250,000 occurring each year. An ACL tear is a season-ending injury, but does it signal the end of an athlete’s career? Not necessarily.

ACL tears affect 250,000 athletes each year Click To Tweet

So how often do athletes with ACL tears return to the sport they love? Dr. Joshua Harris, a Houston Methodist orthopedic surgeon, sought out to find just that. He matched athletes with ACL tears in the National Football League, National Basketball Association, National Hockey League, Major League Soccer and the X Games to athletes without tears based on age, experience and pre-tear performance.

“In addition to determining how often these athletes are able to return to sport after an ACL tear, our studies also revealed interesting patterns in ACL tears,” Dr. Harris said. “For example, we were able to determine which NBA playing positions had a harder time recovering and which knee was more susceptible to ACL tears in MLS players.”

National Hockey League

Athletes in the NHL had a return to sport rate of 97 percent – the highest rate of all major sports leagues. Left-handed shooters are more likely to tear their ACL, but all performed better after returning to the ice.

National Football League

Because the rates of ACL tears in the NFL are so high and specific offensive and defensive positions are unique in their cutting and pivoting demands on the knee, Dr. Harris and his team decided to narrow their research for this study to quarterbacks. The researchers found quarterbacks have a return to sport rate of 92 percent and, on average, played for five years after returning from an ACL tear, which proved ACL tears are not career-ending injuries for quarterbacks.


National Basketball Association

Dr. Harris found that 62 percent of ACL tears in the NBA occur in the second half, mostly in the fourth quarter of the game, possibly due to fatigue. Overall, NBA athletes have a high return to sport rate of 86 percent. Guards have the most difficult time returning to sport, while centers have the most predictable outcomes.

Major League Soccer

While most injuries in Major League Soccer athletes are non-contact injuries, these players tend to have more ACL tears in their left knee and have a 77 percent chance of returning to the field after an ACL tear.

“Because of the cutting and pivoting nature of soccer, MLS players may have more ACL tears in the leg they plant with,” Dr. Harris said. “The majority of soccer players kick with their right and plant with their left, which may explain why they tend to have more ACL tears in their left knee.”

X Games

Dr. Harris and his team looked specifically at skiers and snowboarders. Skiers tend to have more tears in their left knee and had an 87 percent chance of returning to their sport. Snowboarders had a 70 percent return to sport rate and won more medals after recovering from an ACL tear.

“This injury can happen to anyone,” Dr. Harris explained. “Researching ACL tears in athletes helps all of our patients because we are able to evaluate treatments and bring the best solutions back to our practice.”

Rethinking osteoarthritis

My knee pain started in my late 20s. I was overweight and the pain didn’t exactly encourage me to keep moving. Now, more than a decade later, the osteoarthritis (OA) in my knees is much worse. Other than pain and stiffness, it is the grinding that bothers me the most. I know that I will probably need a knee replacement eventually.

When you have OA, your joints ache. You feel stiff. Your knees creak and squeak like an unoiled Tin Man. Your hips tell you when it’s going to rain, and the pain is deep and consuming.

The term “arthritis” characterizes more than 100 different rheumatic diseases and conditions ranging from Lyme disease to autoimmune diseases such as lupus. When most people refer to arthritis, they are usually referring to OA, the most common form of arthritis, which affects 27 million people and is the leading cause of disability in the United States.

Osteoarthritis (OA) affects 27 million Americans. OA deteriorates cartilage, joint lining, ligaments and bone.

Don’t be fooled into thinking that OA only affects seniors. When it comes to this disease, it affects people of all ages.

Also known as the wear-and-tear form of arthritis, OA is a degenerative joint disease that affects cartilage, joint lining, ligaments and bone. It can cause joint pain, swelling, tenderness and stiffness, and can restrict joint mobility. It commonly affects joints at the ends of the finger and thumb, also in the knees, hips, hands, neck and back.

Who gets it?

OA has many contributing factors beyond wear and tear that determines who get the disease and when:

  • Age: OA is a disease often associated with aging because over time, many seniors develop the disease because time has a way of wearing away the cartilage in the joints
  • Gender: After age 55, women are more likely than men to have OA
  • Genes: OA in the hands, in particular, is more closely associated with genetics. Also, certain genetic defects in cartilage can lead to OA
  • Injury and Overuse: Activities that impact and cause injury to the joints, such as playing sports, or soft tissue injury, such as ACL tears, can increase chances of developing OA, even at a young age. Also, jobs that require repetitive motion and heavy lifting can increase the odds of developing OA
  • Weight: Being overweight or obese can cause significant wear and tear on the weight-bearing joints especially in the knees, hips, ankles and feet
Osteoarthritis affects 27 million people and is the leading cause of disability Click To Tweet

Treating osteoarthritis

It is better to treat OA early because the pain and damage to the affected joint can progress over time. Treatment options, which depend on the severity of the joint damage, include taking anti-inflammatory medications, reducing body weight, exercise to strengthen muscles that support the joint, arthroscopy and as a final option — joint replacement surgery.

To learn more about treating osteoarthritis and joint replacement options, visit Houston Methodist Orthopedics & Sports Medicine online.

Recovering from a sports injury

 have been playing football since I was 10 years old. Like most football players, I’ve had sprains and scrapes, but had never experienced an injury that kept me from the game I love. But during a game in 2013, I felt the fear and panic that comes with a season-ending sports injury. 

I’m the starting center for Rice University. Rice and the University of Houston have been sports rivals for years, and the teams have played an annual football game since 1971. On Sept. 21, 2013, we were playing against UH at NRG Stadium. We lined up to kick an extra point when my right arm was caught between our long snapper and a UH player. I felt the weight crushing down on my arm and saw the doctors rushing toward me, but it took me a moment to feel the pain and realize that my right arm was broken in several places. Intense pain was all I could feel, and all I could think was that I’d just experienced my final play of college football.

I was taken off the field and had X-rays taken at the stadium before being transported via ambulance to Houston Methodist Hospital. Dr. Shari Liberman was on call that night. By the time I met her, I was panicking about everything – using my arm again, finishing college, playing football, getting a job, having a normal life. Dr. Liberman calmed me down and explained the extent of my injury and exactly how she was going to fix it. She didn’t sugarcoat anything and told me recovery would be hard, but that regaining normal use of my arm was possible.

I've played football since I was 10. In 2013 I experienced the panic that comes from a sports injury Click To Tweet

I needed surgery as soon as possible, but we had to wait four days for the swelling to go down. Dr. Liberman planned to put my arm back together using titanium plates and screws. However, during surgery she found that the titanium wasn’t going to work because the thread on the screws was too fine for the extent of my injury. She removed the titanium plates and screws and replaced them with stainless steel. Eight hours later, the surgery was done. I stayed in the hospital five more days for observation and treatment.  

For the next two months, my arm was in a locked brace to give the bone time to heal properly, but the brace made even simple tasks difficult. I had amazing family and friends supporting me, but I could not wait to get that brace off. As soon as the brace came off, I started rehabbing with Ricardo Young, a certified hand therapist at Houston Methodist. When Ricardo first started working with me, I was barely able to move my arm because I’d lost so much muscle strength. I had therapy nearly every day for several months and slowly regained my strength and mobility.

Before I knew it, I was able to start training with the Rice athletic staff. A few weeks after that, I was able to work out with the football team again. In June 2014, less than a year after that fateful game and play, Dr. Liberman cleared me to play football again – just in time to start practicing for the 2014-15 season, which will be my last as a Rice college student. 

After such a severe injury, I thought I would never play again, but I’m a starter! It was a feeling of relief and excitement to be back on the field with my teammates. I don’t even worry about my elbow – I just play football. And, it’s all thanks to Dr. Liberman and Ricardo. Go Owls!

Beyond Friday Night Lights

mployment of athletic trainers is expected to increase 30 percent between 2010 and 2020, especially in schools and youth leagues. Why? Because the long overdo realization that athletic trainers are essential members of the teams they support. They provide not only locker room and training guidance but also sideline medical care for everything from cuts to concussions. 

Approximately 8,000 children are treated in emergency rooms each day for sports-related injures. (Statistic via
Approximately 8,000 children are treated in emergency rooms each day for sports-related injures.

Over the years, we’ve all seen the number of sports leagues increase and the offseason time decrease. Often, students are going from one sport to the next without a real break—leaving their bodies ripe for injury.

Scott Tidwell, an outreach coordinator and athletic trainer with Houston Methodist Orthopedics & Sports Medicine, says the increase in injuries is driving the demand to have athletic trainers involved in the prevention and evaluation of sports injuries.

As the parent of a Hardin football player, Scott doesn’t go to the games just to watch his son play; he goes to work. It’s not unusual to see him on the sidelines of a Friday night varsity football game or a junior varsity basketball game at Hardin High School in Hardin, Texas.

Athletic trainer employment is expected to increase 30% due to the sideline medical care these experts provide Click To Tweet

Scotts visits once a week to work with athletes in grades seven to 12 at Hardin Junior High and High schools. He checks to see if an athlete is following the treatment plan provided by their doctor or physical therapist or evaluates a new injury. He also works with the coaches on everything from conditioning and equipment to nutrition in order to minimize injury.

Through Scott’s weekly visits to the Hardin campuses, he becomes familiar with the athletes and their families. This familiarity proved invaluable to Zane Drake, a football and baseball player at Hardin High School. After tackling an opponent during a Friday night game in 2010, then 13-year-old Zane was removed from the game.


I don’t like to admit when I’m in pain. But, after that tackle, I felt tingling in my neck and legs and could tell I wasn’t functioning correctly. Scott was there and knew immediately something was wrong. He got me on a stretcher and helped me keep calm.


Zane was flown to a nearby hospital to be checked for a suspected neck injury and was diagnosed with a stinger, a minor nerve injury common in athletes in high-contact sports. Since then, Zane has dealt with ankle injuries every football season. But with every injury, Scott has been there with guidance and advice.

Scott says it’s about connecting the Houston Methodist level of care with the community that he’s in that day. Whether he’s visiting Hardin, Onalaska or High Island, he’s incredibly passionate about being able to help the coaches, athletes and families of the communities he works in. 

For more information about the athletic training services provided by Houston Methodist, call the Houston Methodist Sports Medicine Hotline, staffed 24/7 by athletic trainers, at 713.441.8440.


5 signs you may need a knee replacement

More than 600,000 knee replacements are performed each year in the United States, and an aging population will continue to drive that number up. If knee pain is affecting your daily life, it might be time to ask your physician about a knee replacement.

Before you take another pain reliever, consider these five signs from Dr. Stephen Incavo, an orthopedic surgeon at Houston Methodist, that suggest it’s time for a knee replacement.

Sign #1: Decrease in activity level or quality of life

Knee pain should not affect your daily routine or prevent you from enjoying your favorite activities. If you experience in a decrease in activity level or quality of life, talk to your doctor.

Sign #2: Pain and/or stiffness at night

If you dread the evening because your knees begin to stiffen up or become painful, you might be a good candidate for a knee replacement.

“Some patients will only have knee pain or stiffness at night, so they think they don’t need a knee replacement. It isn’t normal to be unable to sleep at night due to knee pain.”

More than 600,000 knee replacements are performed each year in the United States Click To Tweet

Sign #3: Non-surgical options no longer help

In some cases, your physician may recommend trying non-surgical options, such as physical therapy or anti-inflammatory medicine, to provide pain relief. If the non-surgical treatment doesn’t help or stops helping, don’t hesitate to go back for a visit.

“Don’t wait too long after non-surgical options stop helping to come back in. The goal is to get you back to a happy, pain-free life, but you have to tell your doctor when something isn’t working for you.”

Sign #4: Future prognosis is not good

For many, your knee pain slowly erodes activity level or quality of life. But if the condition of your knee will continue to worsen, why wait? 

“So many patients with arthritis know they will eventually need a knee replacement, but think they aren’t ready for it yet. But think about your current situation. Ask yourself if you want to enjoy your present years or wait until you’re older and potentially lose all mobility.”

Sign #5: The first replacement has not helped

Unfortunately, not all knee replacements function properly and may require a revision surgery to correct the problem. 

Reviewed by Dr. Stephen Incavo

The difference between life and death for student athletes

Since 2008, more than 200 student athletes across the nation have died on the field. I think we can all agree that number is way too high. The majority of student athletes are required to get a pre-participation physical, but some medical providers use a one-size-fits-all approach that can put the lives of student athletes at risk.

Since 2008, more than 200 student athletes across the nation have died on the field Click To Tweet

On May 31, Houston Methodist Orthopedics & Sports Medicine will host its annual pre-participation physical event at Reliant Center. Physicians and staff will check the athlete’s height, weight, vision, blood pressure, pulse, range of motion, joint strength, and heart and lung function. If a serious problem is detected, they will see a Houston Methodist cardiologist, neurologist or orthopedic surgeon on site.

“For example, if we hear an irregular heartbeat or see a personal history that is concerning for heart disease, that student athlete will be directed to our cardiology station where they can have an electrocardiogram, or EKG, or echocardiogram and be evaluated by a cardiologist,” said Vijay Jotwani, M.D., a primary care sports medicine physician with Houston Methodist. “If further testing is needed, an appointment can be coordinated for the following week. We feel that having on-site experts in numerous specialties enables our physicians to provide complete, personalized care for our student athletes.”

Jotwani stresses that getting a proper physical from medical providers who are knowledgeable about student athletes is essential for a safe and healthy season.

“At our event, we screen student athletes with a family history of heart disease for a disorder called hypertrophic cardiomyopathy, which is the most common cause of sudden cardiac death in athletes under the age of 35,” said Kevin Lisman, M.D., a Houston Methodist cardiologist and lead cardiologist for the event. “What we don’t do is order an EKG for every student. This practice can sometimes cause students to receive a false positive on their EKG. We want to make sure the student athlete is healthy enough to compete while not causing any unnecessary worry for them or their families or driving up health care costs.”

The pre-participation physical event is open to all students ages 12-18. Parents can download the necessary forms at the pre-participation physical event page.

Event details

What: Houston Methodist Pre-Participation Physical Event

When: Saturday, May 31, 2014, 9 a.m. – 12 p.m.

Where: Reliant Center

Free parking with voucher in the Orange Lot at the corner of Holly Hall and Fannin.

Download parking voucher here.

Cost: $15 per student athlete, cash only.

Before leaving the event, be sure to meet the Houston Texans cheerleaders and throw a football into a giant inflated Toro. It’s fun for everyone.